Account receivable billing tips

What is Account Receivables?

Receivables are defined as amounts due and expected to be collected by billing / provider’s office for the services provided to individuals. In Medical Billing, receivables are handled by Account Receivables Department. Account Analyst plays a crucial role in identifying and resolving issues which helps to reduce or clear receivables.

What is the purpose of Claims review & AR Analysis?

The purpose of claim analysis is to identify and resolve medical claims billing and reimbursement issues toward maximizing collections and minimizing accounts receivables. It helps to ensure timely, accurate and final settlement of health insurance claims and patient bills by insurers or patients as appropriate. The scope of claim analysis is applicable to all health insurance claims and patient bills that have not been fully and finally settled by liable party or parties comprising health insurers, patients and others. It is the responsibility of the Accounts Receivables Analyst to ensure that AR is under control & acceptable by industry standards.

What is the scope of AR Department? 

AR Department has to ensure steady inflow of money from the insurance company. The main motive of this department is to collect money for all the treatments taken by the patients in a timely fashion. Usually the turn around period for the payment by the insurance company is 30 – 45 days. Once the limit is exceeded AR department has to make an enquiry for the delay. 

There are various reasons for the delay like:

e) Correct details may not have been provided to the insurance companies.

f) Claims were sent correctly but Insurance Company may not have received the claims.

g) The checks issued might have been sent to the wrong address.

h) The insurance company may delay the payments if they have a backlog and they would inform us by a letter that they have received the claims and would be making the payments shortly.

AR department acts as a hub around which other departments revolve. This department can gather & update lot of billing information which is required to settle a claim. Account analyst uses various reports available in billing software to identify claims which have not been settled. 

The Medical billing software is capable of running reports that pull out claims that are unpaid for greater than 30 days. These are called aging reports and these reports show pending payments in slots such as 0 – 30 days, 31-60 days and 61-90 days. Claims filed within the last 30 days will find themselves in the first slot (0-30days). Claims that are more than 30 days but less than 60 days old will be found in the 31-60 days slot. A glance at this report will show the AR personnel the claims that need to be followed up on with the insurance company. 

Claims will be followed up over the telephone or by written correspondence. It would be necessary to find out why the claims are yet to be paid and what needs to be done to have these claims paid. The delay and denials will be corrected by the billing office in coordination with the physician’s office and the insurance carriers. The same applies when patient billing statements are sent out. The patient is given 3-4 weeks to pay the bill and if the payment is not received with in that time, the billing office will follow up with the patient

Building rapport with the Insurance Representatives

In an AR Follow-up, while calling the Insurance Company, we need to develop a certain level of professional relationship with the Insurance Representatives. This would help us find solutions for cases where the claims have been denied consistently for various reasons including Global Issues. In some instances, the representatives might even turn hostile and might not even reveal much of the required information, which could prove vital in proceeding further on the claims and we have to be very careful in handling situations like this.
The AR Representative should have strong interpersonal & communication skills and should be able to make the Insurance Representatives feel comfortable and also should make the call easy going. Any information, which could help us find the solution for an issue, should be obtained over the call.

For instance, after a few follow up on the pending claims and building viable working relationship with a particular insurance carrier, the representative was able to see that the team was working on legitimate claims that could be worked on. We were asked to send a fax with nearly 100 claims and the relevant information. The Insurance office worked on all the claims and reverted back with status information on fax.

Working on Underpaid Claims

The Patient’s Account including the Demographics, Claims & Payment’s history, Follow up Notes etc has to be analyzed thoroughly before making a call to the Insurance Company regarding the status of any pending claim. If the Insurance has already made a payment on a claim and if that payment’s found to be lower than the Contract Fee Schedule, then this issue needs a special attention, as collectively the balance on the claims which are underpaid constitute a significant portion of the Accounts Receivable and this portion can be definitely converted into Revenue. This task could be cumbersome or complex, but an AR Representative would achieve it, using his/her experience, knowledge, intelligence & skills. Our team also reverts back to the practice with changes in the billing guidelines – as in, revising billed amounts – to achieve maximum value on contracted payments.

When do we call patients?

•When there is no insurance coverage information found in the Demographics Section of the Patient’s Account.
•When the Insurance Company has denied a claim stating that the Patient is not eligible for coverage at the Time Of Service, where the Date Of Service could be prior to the effective date or after the termination date of patient’s insurance coverage.
•When there is a Patient Balance due in the Patient’s Account.
•When any personal info like Patient’s name, Social Security Number, Date of Birth, Address etc is found to be incorrect in the Patient’s Account.

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